Airway Management Knowledge Research Articles

Simulation in airway management teaching and training.

There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios. Trainees also learn non-technical skills such as communication, teamwork, and coordination. A wide range of airway simulators are available. However, texture surface characteristics vary from one type to another. The simulation-based airway management training requires availability, understanding, faculty development, and a structured curriculum for effective delivery. This article explored the available evidence on simulation-based airway management teaching and training.

Prehospital emergency anaesthesia: an introductory guide for paramedics

Prehospital emergency anaesthesia (PHEA) is indicated in a relatively small number of patients. It is a complex procedure that requires an in-depth knowledge of airway management, physiology, pharmacology and human factors and should only be performed judiciously by a competent team. The aim of this article is to provide an overview of the process of PHEA and to describe its indications, practical aspects and potential complications.

Knowledge and Proficiency in Skills of Initial Trauma Management among Healthcare Personnel in Secondary Care

Advanced Trauma Life Support (ATLS) protocols aim to provide good trauma care by enhancing the skills of medical personnel all over the world and while this is well established in developed countries it does not appear to be so in developing countries. This study aims to assess the knowledge and proficiency in initial trauma management skills among health caregivers in some general/cottage hospitals in north central Nigeria. Questionnaires were developed to assess the knowledge and skills of care givers in airway management, respiratory distress and shock. The questionnaires were administered on caregivers involved in trauma care in some general/cottage hospitals that offer secondary care in a state in north-central Nigeria. There were 34 health workers who responded, 10 (29.41%) were doctors and 24(70.54%) were nurses. Their years of experience were from 2 to 35 years (median 14years). Ten (29.41%) had at least one training in ATLS in the past while 24(70.59%) had none. In assessing their management skills, 97.06% reported they were able to assess the airway, 88.24% could do chin lift, 73.53% jaw thrust while 91.18% were able to insert oral airway. Thirty-one (91.18%) were able to recognize respiratory distress, 88.24 were able to administer oxygen using facemask and 64.71% using nasal prong. Thirty (88.24%) could assess a patient for shock, 82.35% could splint fractures for haemorrhage control. Twenty-seven (79.41%) reported knowing parameters to monitor during resuscitation. We concluded that knowledge of airway management was high but proficiency and confidence in performing these skills were low.

Knowledge and Proficiency in Skills of Initial Trauma Management among Healthcare Personnel in Secondary Care

Advanced Trauma Life Support (ATLS) protocols aim to provide good trauma care by enhancing the skills of medical personnel all over the world and while this is well established in developed countries it does not appear to be so in developing countries. This study aims to assess the knowledge and proficiency in initial trauma management skills among health caregivers in some general/cottage hospitals in north central Nigeria. Questionnaires were developed to assess the knowledge and skills of care givers in airway management, respiratory distress and shock. The questionnaires were administered on caregivers involved in trauma care in some general/cottage hospitals that offer secondary care in a state in north-central Nigeria. There were 34 health workers who responded, 10 (29.41%) were doctors and 24(70.54%) were nurses. Their years of experience were from 2 to 35 years (median 14years). Ten (29.41%) had at least one training in ATLS in the past while 24(70.59%) had none. In assessing their management skills, 97.06% reported they were able to assess the airway, 88.24% could do chin lift, 73.53% jaw thrust while 91.18% were able to insert oral airway. Thirty-one (91.18%) were able to recognize respiratory distress, 88.24 were able to administer oxygen using facemask and 64.71% using nasal prong. Thirty (88.24%) could assess a patient for shock, 82.35% could splint fractures for haemorrhage control. Twenty-seven (79.41%) reported knowing parameters to monitor during resuscitation. We concluded that knowledge of airway management was high but proficiency and confidence in performing these skills were low.

Knowledge and Proficiency in Skills of Initial Trauma Management among Healthcare Personnel in Secondary Care

Advanced Trauma Life Support (ATLS) protocols aim to provide good trauma care by enhancing the skills of medical personnel all over the world and while this is well established in developed countries it does not appear to be so in developing countries. This study aims to assess the knowledge and proficiency in initial trauma management skills among health caregivers in some general/cottage hospitals in north central Nigeria. Questionnaires were developed to assess the knowledge and skills of care givers in airway management, respiratory distress and shock. The questionnaires were administered on caregivers involved in trauma care in some general/cottage hospitals that offer secondary care in a state in north-central Nigeria. There were 34 health workers who responded, 10 (29.41%) were doctors and 24(70.54%) were nurses. Their years of experience were from 2 to 35 years (median 14years). Ten (29.41%) had at least one training in ATLS in the past while 24(70.59%) had none. In assessing their management skills, 97.06% reported they were able to assess the airway, 88.24% could do chin lift, 73.53% jaw thrust while 91.18% were able to insert oral airway. Thirty-one (91.18%) were able to recognize respiratory distress, 88.24 were able to administer oxygen using facemask and 64.71% using nasal prong. Thirty (88.24%) could assess a patient for shock, 82.35% could splint fractures for haemorrhage control. Twenty-seven (79.41%) reported knowing parameters to monitor during resuscitation. We concluded that knowledge of airway management was high but proficiency and confidence in performing these skills were low.

Knowledge and Proficiency in Skills of Initial Trauma Management among Healthcare Personnel in Secondary Care

Advanced Trauma Life Support (ATLS) protocols aim to provide good trauma care by enhancing the skills of medical personnel all over the world and while this is well established in developed countries it does not appear to be so in developing countries. This study aims to assess the knowledge and proficiency in initial trauma management skills among health caregivers in some general/cottage hospitals in north central Nigeria. Questionnaires were developed to assess the knowledge and skills of care givers in airway management, respiratory distress and shock. The questionnaires were administered on caregivers involved in trauma care in some general/cottage hospitals that offer secondary care in a state in north-central Nigeria. There were 34 health workers who responded, 10 (29.41%) were doctors and 24(70.54%) were nurses. Their years of experience were from 2 to 35 years (median 14years). Ten (29.41%) had at least one training in ATLS in the past while 24(70.59%) had none. In assessing their management skills, 97.06% reported they were able to assess the airway, 88.24% could do chin lift, 73.53% jaw thrust while 91.18% were able to insert oral airway. Thirty-one (91.18%) were able to recognize respiratory distress, 88.24 were able to administer oxygen using facemask and 64.71% using nasal prong. Thirty (88.24%) could assess a patient for shock, 82.35% could splint fractures for haemorrhage control. Twenty-seven (79.41%) reported knowing parameters to monitor during resuscitation. We concluded that knowledge of airway management was high but proficiency and confidence in performing these skills were low.

Knowledge and Proficiency in Skills of Initial Trauma Management among Healthcare Personnel in Secondary Care

Advanced Trauma Life Support (ATLS) protocols aim to provide good trauma care by enhancing the skills of medical personnel all over the world and while this is well established in developed countries it does not appear to be so in developing countries. This study aims to assess the knowledge and proficiency in initial trauma management skills among health caregivers in some general/cottage hospitals in north central Nigeria. Questionnaires were developed to assess the knowledge and skills of care givers in airway management, respiratory distress and shock. The questionnaires were administered on caregivers involved in trauma care in some general/cottage hospitals that offer secondary care in a state in north-central Nigeria. There were 34 health workers who responded, 10 (29.41%) were doctors and 24(70.54%) were nurses. Their years of experience were from 2 to 35 years (median 14years). Ten (29.41%) had at least one training in ATLS in the past while 24(70.59%) had none. In assessing their management skills, 97.06% reported they were able to assess the airway, 88.24% could do chin lift, 73.53% jaw thrust while 91.18% were able to insert oral airway. Thirty-one (91.18%) were able to recognize respiratory distress, 88.24 were able to administer oxygen using facemask and 64.71% using nasal prong. Thirty (88.24%) could assess a patient for shock, 82.35% could splint fractures for haemorrhage control. Twenty-seven (79.41%) reported knowing parameters to monitor during resuscitation. We concluded that knowledge of airway management was high but proficiency and confidence in performing these skills were low.

Self-Confidence in Endotracheal Intubation Among Pediatric Interns: Associations With Gender, Experience, and Performance

Background and ObjectiveSupervisors’ decisions regarding procedural readiness are influenced by resident confidence. Confidence is a valuable metric if we understand how it correlates with trainee characteristics and procedural competence. Our objective was to evaluate the relationship between self-reported confidence in endotracheal intubation (ETI) and pediatric interns’ characteristics (gender, prior intubation experience) and performance (airway management knowledge, demonstrated skills on airway trainers). MethodsThis was a secondary analysis of a randomized, controlled trial of an airway management curriculum. Gender and prior intubation experience were reported on a preparticipation questionnaire. Interns’ performance was measured 1) using a 14-item knowledge-based assessment of airway management and 2) as time to successful intubation across 4 simulated intubation scenarios. After completing the curriculum and assessment, interns reported retrospective precurriculum and current postcurriculum confidence with ETI using a 10-point Likert scale. ResultsForty-nine interns participated, of whom 16 (33%) were male. Eleven (22%) had ≥1 previous successful intubation. Median [interquartile range] pre- and postcurriculum confidence scores were 3 [2, 5] and 6 [5, 8], respectively. Male interns reported higher precurriculum confidence than females (median difference: 2.0; 95% confidence interval: 0.1, 3.9); postcurriculum confidence among males was also higher but not statistically significant. There was no correlation between self-reported precurriculum confidence and prior experience. There was no correlation between pre- or postcurriculum self-reported confidence and performance on the knowledge-based assessment or time to successful intubation on airway trainers. ConclusionsMale pediatric interns self-report higher initial confidence in ETI compared to females. Self-reported confidence did not correlate with prior experience, airway management knowledge, or intubation performance on airway trainers.

Multi-specialty knowledge on surgical a management: Implementation of an educational initiative

PurposeDeficiencies in airway management knowledge can result in harm, especially in tracheostomy patients. Our objective is to assess the degree of knowledge in different medical specialties, before and after targeted airway education. Materials and methodsA lecture on tracheostomy management was prepared for Otolaryngology, Anesthesia, Emergency Medicine, General Surgery, Oral and Maxillofacial Surgery (OMFS), Internal Medicine (IM), and Family Medicine (FM). Before the lecture, a 12-question quiz on surgical airway knowledge was administered, and demographics from participants collected. Immediately following the lecture, participants were asked to retake the quiz. Performance was assessed. Population baseline characteristics included, specialty, years of practice, and previous education. ResultsA paired t-test evaluating pre- and post-lecture results showed a 34.2% improvement for all participants (n = 168) overall (2.7 points, p < 0.001). Providers with more years of practice performed better. Otolaryngology and OMFS performed the highest on the baseline test while FM and IM performed the lowest. The providers who reported previous standardized training from the hospital system, informal instruction on the ward, or had the topic covered in their degree program performed better compared to those without previous education (ANOVA, 3.5 points, p < 0.01). Providers who underwent formal training in their degree program performed the best. A Likert scale with self-assessment of comfort with surgical airway correlated positively with the performance on the quiz. ConclusionVariability in tracheostomy knowledge based on specialty and years of training exists. We demonstrate that formal education on tracheostomy and surgical airways improved quantitative measures of knowledge.

Athletic Training Students Demonstrate Airway Management Skill Decay, but Retain Knowledge over 6 Months

Context: Airway management (AM) knowledge and skills are taught in all athletic training programs; however, research suggests that skill decay occurs with acute care skills as length of nonpractice increases. Objective: Evaluate retention of AM knowledge and skills, specifically oropharyngeal airway (OPA) and nasopharyngeal airway (NPA) use, in athletic training students. Design: Cross-sectional study. Patients or Other Participants: Twenty-five students (8 males, 17 females; age = 21.12 ± 1.42 years) enrolled in Commission on Accreditation of Athletic Training Education–accredited professional athletic training programs. Intervention(s): Participants' AM knowledge and skills were assessed 5 times (baseline–T4). The baseline assessment was followed by an educational review session. Participants were reassessed (T1) before being randomly assigned to 2 groups. The experimental group's AM knowledge and skills were reevaluated at 1 month (T2), 3 months (T3), and 6 months (T4), and the control group's at 6 months (T4). Main Outcome Measure(s): Dependent variables of AM knowledge and skills scores. Groups served as the independent variable. Repeated-measures analysis of variance with between-participants and within-participants effects assessed changes in knowledge skills scores. Results: Testing revealed no significant differences between the groups on knowledge (F2.00,46.00 = 0.37, P = .70) and overall clinical skills (F1.57,36.17 = 0.09, P = .87). A significant main effect for time on knowledge (F2.00,46.00 = 28.44, P &amp;lt; .001) found baseline scores were different from scores at T1 and T4. A significant main effect for time on OPA skills (F1.50,34.60 = 65.02, P &amp;lt; .001) and NPA skills (F1.62,37.31 = 106.46, P &amp;lt; .001) found baseline scores were different from scores at T1 and T4 and T1 score was different from T4 score. Conclusions: Both groups retained AM knowledge over a 6-month period, whereas OPA and NPA skills decayed from review session to 6-month follow-up. The lack of significant differences between the groups suggests that subsequent testing may not affect retention of AM knowledge and skills.

A Multifaceted Inter-Specialty Approach to Teaching Advanced Airway Management

Objective: Our aim was to establish a multifaceted interspeciality advanced airway training program for residents using multiple teaching methods, including lectures, animal models, and simulation scenarios. Methods: 41 residents in Otolaryngology, General Surgery, Anesthesia, and Emergency rotated through seven stations, each representing a teaching objective in airway management. Residents completed a pre and post questionnaire about their level of skill and knowledge of airway management. Results: The mean pre-post difference calculated showed a self-perceived improvement in skill and knowledge in all topics covered (p<.05), namely cricothyroidotomy, emergency tracheostomy, controlled open tracheostomy, fiberoptic bronchoscopic intubation, laryngoscopic video-assisted intubation and management of the pediatric airway. The majority rated the course highly in terms of usefulness and all would recommend the course to their colleagues. Conclusion: The multifaceted interspecialty course was well received by all residents. Self-perceived improvement was found for all topics covered. The interspecialty aspect allowed improvement in communication and professionalism.

A 12 month retrospective study of airway management practices

Australian emergency nurses have a primary role in advanced airway management. Consequently, they need to be competent in, and have a systematic approach to, airway preparation, management and rescue. The aims of the study were to (i) identify all patients undergoing endotracheal intubations in the emergency department; (ii) describe patient characteristics, diagnosis and disposition; and, (iii) review the introduction of an advanced airway management algorithm and difficult airway equipment tray. A 12 month retrospective study was undertaken (1/1/2006 to 31/12/2006) of all patients requiring oral endotracheal intubation. A survey was conducted to determine nursing confidence and practice with intubation and the benefit of introducing an advanced airway management algorithm and a preassembled difficult airway equipment tray. Two hundred and fifty three patients required intubation during the study. The age ranged from neonates/infants to 98 years. Emergency nurses felt confident in assisting with endotracheal intubation and regularly encountered airway rescue situations. The pre-assembled difficult airway equipment and airway management algorithm led to improved confidence and practice. Endotracheal intubation is a regular ED intervention. Emergency nurses need to have knowledge of airway management and rescue. A developed airway management algorithm and difficult airway equipment tray improved nursing confidence, expertise and response time in advanced airway interventions.

Management of the Difficult and Failed Airway.

Management of the Difficult and Failed Airway. Edited by Orlando R. Hung, M.D., and Michael F. Murphy, M.D., F.R.C.P.C. New York, McGraw-Hill, 2008. Pages: 510. Price: $129.00.Few scenarios in the practice of medicine stoke the fires of immediate concern quite like encountering a difficult and failed airway. Unfortunately, adequate prediction of potentially challenging anatomy remains far from a perfect science despite having been the cornerstone of modern anesthetic practice for decades. The ever present possibility for disaster fuels continuing discourse not only throughout anesthesia but also across many other disciplines over methods and techniques with which to approach such problematic cases. The magnitude of this problem is reflected in the seemingly endless supply of novel and innovative airway devices and the sheer quantity of ongoing research ventures aimed at improved understanding of the complex interplay between anatomy, pharmacology, and airway manipulation. Indeed, the absolute increases in the volume of both our knowledge and technology are exceeded only by the rate at which they are escalating.Whether the discipline is anesthesiology, emergency medicine, intensive care, or first response, securing the difficult and challenging airway in virtually any situation is the focus of this extremely useful book. Edited by two of Canada’s well-regarded airway management experts, the text offers a number of additions to existing difficult airway manuals in both its content and its formulation of the difficult airway approach.Starting with a well-written and informative introduction to emergency airway algorithms and their similarities to and discrepancies from the American Society of Anesthesiologists Difficult Airway Algorithm, the book delves into a thoroughly informative discussion on how the editors’ Canadian twist on established practice results in improvements to airway management that can be applied to virtually any emergent situation. The text continues with a comprehensive background discussion of devices in and techniques for the difficult airway that serve as the basis of the aforementioned algorithmic progressions. These initial chapters build the foundation for the true value of this text.The book includes topics that vary from airway management in the intensive care unit setting to the management of a motorcyclist with a full face helmet. Each chapter tackles a new airway management dilemma with an informal question and discussion style that permits both straightforward reading and rapid browsing and referral. Through analysis of the pitfalls and caveats associated with unique situations encountered at every step in the process of securing the airway, the authors manage not only to elucidate the fundamental principles inherent to emergent airway control but also to foster an objective approach to the control of the airway in any potential scenario. Each chapter even concludes with a small set of self-evaluation questions that are certainly beneficial to readers, especially those still in training.It is difficult to edit the perfect text, and this book is no exception. It is not as comprehensive as some of the other available references on the market, and a subset of readers may not embrace the novel approaches inherent to the presented algorithms. In addition, it is surprising to note that the discussion on “the best way to confirm placement of an endotracheal tube in the trachea,” included in the chapter entitled “Airway Devices and Techniques,” is too casual and possesses a reference list that ignores a number of rather important citations. The same complaints could be carried over to the discussions on “how do prehospital providers confirm and maintain intratracheal placement of the ETT” in chapter 13 and the chapter on “Aspiration: Risks and Prevention.” Both sections certainly lack depth and, yet again, an appropriate selection of references.These criticisms, however, should not overshadow the text’s value to both junior trainees and veteran anesthesiologists alike. Well written, functionally organized, and implementing algorithms that may be complementary to the established knowledge base of the majority of readers, Management of the Difficult and Failed Airway receives our highest recommendation for any practitioner interested in improving his or her knowledge of airway management.*Advocate Illinois Masonic Medical Center, Chicago, Illinois.ramez.salem-md@advocatehealth.com

Ateliers « intubation difficile » : impact sur les connaissances et les pratiques

Objectives To evaluate the impact of difficult intubation workshops on airway management knowledge and daily medical practice in anaesthesiology. Study design Prospective survey. Methods The participants to the workshops accredited by the French college of anaesthesiologists (Cfar) in 2003 were invited to answer to MCQ before, immediately and three months after the course. They also completed a questionnaire provided during the workshop and three months later, focusing on medical practice and their own organization in the area of difficult intubation before and after the workshop. Results One hundred (and) seven participants responded to the immediate evaluation (MCQ and questionnaire) whereas 32 responded to the delayed evaluation performed three months later. A subjective scale was used to assess the level of knowledge in difficult intubation (0: lowest level, 10 highest level).The mean score for subjective knowledge considering difficult intubation was 4.7 ± 2.3 before the course and 6.9 ± 1.6 at 3 months ( P < 0.001). The mean scores attributed to MCQ were not different before and after the workshops. Participants expected complementary practical training (65%) and theoretical courses (40%). Delayed evaluation revealed that 25/32 participants had to deal with difficult intubation during their clinical practice after the workshop, but 3 cases (12%) could not be managed with success. Defects could be observed in terms of organization: no difficult airway trolley (22%), no predefined difficult airway algorithm (66%), and information: no written information given to the difficult airway patient (44%), and no information given to the difficult airway patient's home doctor (91%). Discussion These results showed that difficult intubation remains a real problem for anaesthesiologists. They also revealed differences between subjective and objective knowledge and pointed out defects in terms of organization and management which should be improved.

How competent are obstetric and gynaecology trainees in managing maternal cardiac arrests?

SummaryThe recent Confidential Enquiry (2000 – 2002) has emphasised ‘emergency drills for maternal resuscitation should be regularly practised in clinical areas in all maternity units’. It was therefore planned to assess the knowledge of airway management and ventilation among obstetrics and gynaecology trainees in the Yorkshire Deanery (Training Region). Questionnaires were given to trainees attending the Modular Training Programme and were collected on the same day. A total of 71 questionnaires were collected which represents 62% of the 113 trainees in Yorkshire region. Replies were received from 39 registrars, 27 Senior House Officers (SHO), four Senior SHOs (SSHO) and one clinical fellow. MRCOG Part 1 was passed by 52% and 36% of trainees had MRCOG Part 2. A total of 69% of trainees did not know that chin lift opens the airway in some 70 – 80% of patients; 50% of trainees were not aware why jaw thrust is preferred over chin lift; 76% of the trainees knew the most common cause of airway obstruction in a patient with an altered level of consciousness – the tongue falls back and obstructs the pharynx (‘swallowing the tongue’). Knowledge of the main cause of airway obstruction was good among obstetrics and gynaecology trainees, but their understanding of how to manage this was found to be relatively poor. Attendance at a local Basic Life Support course should be compulsory for obstetric and gynaecology trainees early in their career.

The airway.

The airway.